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Abstract Background Oxidative damage has been implicated in multiple neurodegenerative diseases, including epilepsy. Selenium, in the form of selenoproteins is an integral part of the human antioxidant defense system. Though a relationship between the altered selenium levels and epilepsy has been reported, limited evidence is available about the expression pattern of selenoproteins in epileptic patients. Objective This study aimed to determine the serum selenium levels in idiopathic epileptic and healthy individuals. Expression profiling of selenoproteins (GPx1, TRxR1 and SEPW1) both at mRNA and protein levels was also evaluated. Methods Serum selenium levels of 30 patients with idiopathic generalized epilepsy and their age and gender matched 30 healthy controls were measured. Protein levels of Serum Glutathione Peroxidase 1 (GPx1), Thioredoxin Reductase 1 (TRxR1) and Selenoprotein W (SEPW1) were estimated using ELISA. mRNA expression of GPx1, TRxR1 and SEPW1 were determined using qRT-PCR. Results The mean values for serum selenium levels in cases and controls were 37.6 ± 2.0 µmol/ml and 38.9 ± 2.7 µmol/ml, respectively. Selenium levels in cases were significantly lower as compared to controls (p = 0.031). No statistically significant differences were observed between the serum levels of selenoproteins GPx1, TRxR1 and SEPW1 in epileptic patients and the healthy group. GPx1 and TRxR1 expression was found to be down regulated (0.34 and 0.13 folds respectively) whereas SEPW 1 was found to be 0.04 folds up regulated in epileptic patients compared to the healthy subjects. Conclusion Selenium deficiency observed in epileptic patients suggests the association between serum selenium levels and epilepsy. This study provides the information about the selenium status in Pakistani population and helps in understanding the role of selenium in the prevention of epilepsy. Graphical Abstract

Melt-cast explosives are the most widely used energetic materials in military composite explosives, researchers have been unremittingly exploring high-energy and insensitive melt-cast explosives. In this work, a series of dinitrophenyl-oxadiazole compounds were designed and prepared. These compounds have an ideal low melting point (80–97 °C), good detonation performance (detonation velocity D = 6455–6971 m/s, detonation pressure P = 18–19 GPa) and extreme insensitive nature (impact sensitivity ≥60 J, friction sensitivity >360 N). All these compounds were well characterized by nuclear magnetic resonance, fourier transform infrared spectroscopy, elemental analysis. Compounds 2, 3 were unambiguously confirmed by X-ray single crystal diffraction analysis. As a result, their overall properties are superior to traditional melt-cast explosives trinitrotoluene (TNT) and dinitroanisole (DNAN) which may have excellent potential applications in insensitive melt-cast explosives.

Background: Extensive use of antibiotics has led to emergence of antimicrobial resistance (AMR), hence, challenging the treatment of clinical bacterial isolates. Herbal agents like Curcuma longa (Turmeric) have gained prominence for their wide-ranging effects. This study aimed to identify antibacterial and cytotoxic potential of pure and processed Curcuma longa on respiratory tract bacterial isolates to develop an effective and sustainable treatment option. Methods: This study was conducted from March to October 2023 at Medical Technology Laboratory, Ziauddin University. The antibacterial activity of pure and processed Curcuma longa ethanolic extracts against Moraxella catarrhalis, Klebsiella pneumoniae, Streptococcus pyogenes, and Haemophilus influenzae was checked by agar well diffusion method. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) were determined through microdilution method. Phytochemical composition was qualitatively analyzed and cytotoxic potentials of Curcuma longa were tested through MTS assay. Mean values of turmeric extracts were compared by student’s t-test through SPSS version 17. p-value

OBJECTIVES To ascertain the prevalence of left ventricular hypertrophy in individuals diagnosed with ischemic stroke. METHODOLOGY A cross-sectional study was undertaken in the Department of Medicine, Hayatabad Medical Complex, Peshawar, from October 1, 2020, to April 30, 2021, after obtaining ethical approval. The study included 143 individuals who had evidence of ischemic stroke on a CT scan. These patients were assessed for the presence or absence of left ventricular hypertrophy using transthoracic echocardiography. RESULTS The average age of the participants in the study was 57 years, with a standard deviation of 7.9 years. The sample consisted of 67.8% males and 32.2% females. The average BMI was calculated to be 25.3 + 3.3kg/m2, and 39.9% of the patients were from urban areas. Left ventricular hypertrophy was observed in 16.8% of patients who had experienced an ischemic stroke, with the greatest occurrence rate of 39.9% found in the age range of 50-60 years. There was no significant correlation observed between hypertension, diabetes, location of residence, age, and smoking. CONCLUSION Early and precise identification of the modifiable risk factors during the illness, followed by proper intervention, has the potential to decrease the incidence of debilitating stroke greatly. It is necessary to conduct large-scale population screening studies inside our local community. TTE should be carried out in all acute ischemic stroke patients to optimize the management of these patients.

Background: Enterobacteriaceae are a large family of gram negative bacteria including many genera. The emergence and spread of resistance in Enterobacteriaceae is increasing due to the production of extended spectrum beta lactamase (ESBL) enzymes. Combinations of Beta-lactam/Beta-lactamase inhibitors such as Piperacillin/Tazobactam and Cefoperazone/Sulbactam have good activity against these isolates. The purpose of this study is to determine the antimicrobial susceptibility pattern of Piperacillin/Tazobactam and Cefoperazone/Sulbactam against isolates of Enterobacteriaceae from a tertiary care hospital laboratory of Pakistan. This study validates better options for empirical antimicrobial treatment for this group of difficult to treat pathogens. Methods: A total of 2111 clinical samples were received for culture and sensitivity from both in and outpatients. Samples were inoculated on Chocolate agar, Sheep blood agar and MacConkey’s agar and were incubated for 24 to 48 hours according to standard technique. All isolates belonging to the family Enterobacteriaceae identified by conventional biochemical tests were included in the study. Antimicrobial sensitivities of Enterobacteriaceae were tested and interpreted by Kirby-Bauer disc diffusion method according to Clinical Laboratory Standard Institution criteria. Results: Out of 2111 clinical samples, 214 isolates of Enterobacteriaceae were identified. Escherichia coli was recognized as the predominant pathogen (130/214; 60.75%). Frequency of extended spectrum beta lactamases producing Enterobacteriaceaewas100/214(47%) in 214 samples. Antimicrobial sensitivity was 80% (172/214) to Piperacillin/Tazobactam and 83% (178/214) to Cefoperazone/Sulbactam against the total 214 isolates of Enterobacteriaceae. Conclusion: Piperacillin/Tazobactam and Cefoperazone/Sulbactam are potential and better empirical treatment options for treating isolates of Enterobacteriaceae. This will help in reducing selection pressure on last resort antimicrobials and hence curtail antimicrobial resistance. Key Words: Antimicrobial susceptibility. Piperacillin/Tazobactam. Cefoperazone/Sulbactam. Enterobacteriaceae. Beta lactamases.

Primary explosives are utilized as a reliable initiator for secondary explosives in an extensive range of military and civilian operations. Heavy–metal–based primary explosives are moderate performing, more sensitive, and environmentally hazardous, posing a direct and indirect threat to health and safety. Therefore, heavy–metal–based primaries have been replaced by environment-friendly metal-based primary explosives, such as potassium complexes. This review presents not only a summary of the current progress of new-generation potassium-based primary explosives and their methods of preparation, energetic properties, and applications, but also a further comparison with traditional primary explosives. In addition, this work discusses the necessity of heavy metal–free primary explosives and the major challenges faced in replacing traditional primary explosives.

Objective: To determine indications and outcomes of stem cell transplant in Chronic Myeloid Leukemia in a tertiary care centre in Pakistan. Study Design: Retrospective longitudinal study Place and Duration of Study: Armed Forces Bone Marrow Transplant Center, Rawalpindi Pakistan, from Jan 2002 to Jan 2019. Methodology: Retrospective analysis of all the patients who had undergone transplants for chronic myeloid leukaemia at our centre from 2002 to 2019 was done. Cases enrolled included patients of both genders and any age for whom data related to disease status and follow-up post-transplant was available. Patients with incomplete records and follow-ups were excluded from the study. Results: Out of 73 patients, data from 53 patients was analyzed. At a median follow-up of 40 months, overall survival was 72%. Survival in patients 40 years (50%). Among the three conditioning regimens, Bu16Cy120 was the most commonly used (n=35, 66%) and had better overall survival (n=29, 83%) though statistical significance could not be established (p=0.172). Conclusion: In addition to the established indications of resistance or intolerance to tyrosine kinase inhibitors for bone marrow transplant in CML, the non-availability/ affordability, young age, and lack of access to novel drugs can be included in underdeveloped countries like Pakistan.

Background: Oxidative damage has been implicated in multiple neurodegenerative diseases, including epilepsy. Selenium, in the form of selenoproteins is an integral part of the human antioxidant defense system. Though a relationship between the altered selenium levels and epilepsy has been reported, limited evidence is available about the expression pattern of selenoproteins in epileptic patients. Objective: This study aimed to determine the serum selenium levels in idiopathic epileptic and healthy individuals. Expression profiling of selenoproteins (GPx1, TRxR1 and SEPW1) both at mRNA and protein levels was also evaluated. Methods: Serum selenium levels of 30 patients with idiopathic generalized epilepsy and their age and gender matched 30 healthy controls were measured. Protein levels of Serum Glutathione Peroxidase 1 (GPx1), Thioredoxin Reductase 1 (TRxR1) and Selenoprotein W (SEPW1) were estimated using ELISA. mRNA expression of GPx1, TRxR1 and SEPW1 were determined using qRT-PCR. Results: The mean values for serum selenium levels in cases and controls were 37.6 ± 2.0 µmol/ml and 38.9 ± 2.7 µmol/ml, respectively. Selenium levels in cases were significantly lower as compared to controls (p = 0.031). No statistically significant differences were observed between the serum levels of selenoproteins GPx1, TRxR1 and SEPW1 in epileptic patients and the healthy group. GPx1 and TRxR1 expression was found to be down regulated (0.34 and 0.13 folds respectively) whereas SEPW 1 was found to be 0.04 folds up regulated in epileptic patients compared to the healthy subjects. Conclusion: Selenium deficiency observed in epileptic patients suggests the association between serum selenium levels and epilepsy. This study provides the information about the selenium status in Pakistani population and helps in understanding the role of selenium in the prevention of epilepsy. [ABSTRACT FROM AUTHOR]

Dyskeratosis congenita (DKC), also known as Zinsser–Cole–Engman syndrome, is a telomeropathy typically presenting as a triad of leukoplakia, nail dystrophy, and reticular hyperpigmentation. Reported genetic mutations linked to DKC include DKC1, TINF2, TERC, TERT, C16orf57, NOLA2, NOLA3, WRAP53/TCAB1, and RTEL1. Homozygous, compound heterozygous, and heterozygous mutations in RTEL1 (RTEL1, regulator of telomere elongation helicase 1) gene on chromosome 20q13 are known to cause autosomal dominant as well as recessive DKC. Pathogenic variants of RTEL1 gene in DKC patients include c.2288G>T (p. Gly763Val), c.3791G>A (p. Arg1264His), and RTEL p. Arg981Trp. We report a novel homozygous variant of RTEL1, transcript ID: ENST00000360203.11, exon 24, c.2060C>T (p.Ala687Val), in a patient of DKC presenting with leukoplakia, dystrophic nails, reticulate pigmentation, and positive family history of a similar phenotype. The novel variant, reported as a variant of uncertain significance, may therefore be considered diagnostic for DKC in a Pakistani population.

BACKGROUND: This study aimed to determine the association of single-nucleotide polymorphisms (SNPs) of interleukin-6 (IL-6) gene with the survival and disease status of patients after allogeneic hematopoietic stem cell transplantation. MATERIALS AND METHODS: It was a prospective cohort study of total 102 participants, 51 patients along with their donors who had human leukocyte antigen-identical-matched allogeneic hematopoietic stem cell transplantation (aHSCT). Their pretransplant and posttransplant blood samples were collected for extraction of DNA for genotyping by sequence-specific primers polymerase chain reaction and gel electrophoresis followed by sequencing. The pre- and posttransplant levels of IL-6 were measured using enzyme-linked immunosorbent assay technique. RESULTS: The mean age of our patients was 19.83 ± 12.5 years having males 65 (63.7%) and females 37 (36.3%). The frequency of −174G/C SNP among acute graft-versus-host disease (aGVHD) group was GG = 53.8%, GC = 34.6%, and CC = 11.5%, and for −597G/A SNP, it was GG = 69.2%, GA = 15.4%, and AA = 15.4%. Our results showed that the presence of G allele in both homozygous and heterozygous forms was associated with increased aGVHD incidence, while the homozygous CC and AA mutant genotypes correlated with the lowest number of cases of aGVHD. The polymorphism −597G/A was significantly associated with the incidence of aGVHD with P = 0.04. The GG genotype in −174G/C and −597G/A was found to be significantly associated with aGVHD with P < 0.0001. High serum levels of IL-6 pre- and posttransplant were found to be significantly associated with the incidence of aGVHD with P < 0.0001. CONCLUSION: We concluded that the two SNPs − 174G/C and − 597G/A in the promoter region of IL-6 gene present either in donors or recipients predisposed to increase the risk of development of aGVHD following aHSCT. Their evaluation in our transplant setting may help in the risk stratification of transplant recipients early in time and predict the onset of aGVHD and mortality.

Heterocyclic skeleton (Azoles) and different energetic groups containing high performing explosives are highly emerged in recent years to meet the challenging requirements of energetic materials in both military and civilian applications with improved performance. For this purpose tetrazole (Azole) is identified as an attractive heterocyclic backbone with energetic functional groups nitro (-NO2), nitrato (-ONO2), nitrimino (-NNO2), and nitramino (–NH–NO2) to replace the traditionally used high performing explosives. The tetrazole based compounds having these energetic functional groups demonstrated advanced energetic performance (detonation velocity and pressure), densities, and heat of formation (HOF) and became a potential replacement of traditional energetic compounds such as RDX. This review presents a summary of the recently reported nitro-tetrazole energetic compounds containing poly-nitro, di/mono-nitro, nitrato/nitramino/nitrimino, bridged/bis/di tetrazole and nitro functional groups, describing their preparation methods, advance energetic properties, and further applications as high-performing explosives, especially those reported in the last decade. This review aims to provide a fresh concept for designing nitro-tetrazole based high performing explosives together with major challenges and perspectives.

Background: Hematopoietic stem cell transplantation (HSCT) is therapeutic option for many blood diseases. It has increased risk of complications with incompatible pair. The objective of this study was to determine the frequency of complications in ABO-incompatible HSCT in Pakistan. Materials Methods: This cross-sectional study was conducted at Armed Forces Bone Marrow Transplant Centre , Rawalpindi, Pakistan from 11th August 2018 till 15th March 2021. A sample of 73 ABO-incompatible HSCT patients was selected. Variables were sex, age groups, acute delayed hemolysis, pure red cell aplasia and acute GvHD. All variables being categorical were described by count and percentage with 80%CI. Complications in sample vs. population were compared through chi-square goodness of fit test. RESULTS: Seventy three patients with ABO-incompatible HSCT included 52 (71.23%) men 21 (28.77%) women, and 49 (67.12%) in age group ≤14 years 24 (32.88%) in ≥15 years. Out of 73 patients, eight (10.96%) had acute hemolysis, 26 (35.62%) had delayed hemolysis, four (5.84%) had pure red cell aplasia and 34 (46.58%) had acute GvHD. The observed prevalence in sample was similar to population for acute (p=.46893) and delayed hemolysis (p=.30759) and acute GvHD (p=.55841), while it was different for pure red cell aplasia (p=.00006). CONCLUSION: Most common complication in our study was acute GvHD, followed by delayed hemolysis, acute hemolysis pure red cell aplasia. The observed prevalence in sample was similar to population for acute delayed hemolysis and acute GvHD, while it was different for pure red cell aplasia.

Diffuse large B-cell lymphoma (DLBCL) is the commonest non-Hodgkin lymphoma encountered by hematopathologists and oncologists. Management guidelines for DLBCL are developed and published by countries with high income and do not cater for practical challenges faced in resource-constrained settings. This report by a multidisciplinary panel of experts from Pakistan is on behalf of three major national cancer societies: Society of Medical Oncology Pakistan, Pakistan Society of Hematology, and Pakistan Society of Clinical Oncology. The aim is to develop a practical and standardized guideline for managing DLBCL in Pakistan, keeping in view local challenges, which are similar across most of the low- and middle-income countries across the globe. Modified Delphi methodology was used to develop consensus guidelines. Guidelines questions were drafted, and meetings were convened by a steering committee to develop initial recommendations on the basis of local challenges and review of the literature. A consensus panel reviewed the initial draft recommendations and rated the guidelines on a five-point Likert scale; recommendations achieving more than 75% consensus were accepted. Resource grouping initially suggested by Breast Health Global Initiative was applied for resource stratification into basic, limited, and enhanced resource settings. The panel generated consensus ratings for 35 questions of interest and concluded that diagnosis and treatment recommendations in resource-constrained settings need to be based on available resources and management expertise.

Pakistan is the fifth most populous country with a population of 225 million and has health expenditure accounting for only 2.8 percent of gross domestic product (GDP). Accordingly, there are a limited number of haematology-oncology and transplant centers in the country. The Pakistan Blood and Marrow Transplant (PBMT) group was established in 2020, and this report is the first activity survey from January 2021 to December 2022 focusing on the trends of matched-related donor, haploidentical, and autologous transplants in a developing country. A total of 12 transplant centers contributed data on the modified PBMT survey form retrospectively and 806 haematopoietic stem cell transplants (HSCTs) were carried out during the study duration. Allogeneic HSCT constituted 595 (73.8%) of all the transplants; this is in stark contrast to Western data, where autologous HSCT accounts for the majority of transplants. ß-thalassemia major and aplastic anemia were the commonest indications for allogeneic HSCT, in contrast to Western data, where acute leukemia is the leading transplant indication. Autologous transplants were more frequently performed for Hodgkin’s lymphoma as compared to non-Hodgkin’s lymphoma and multiple myeloma. The use of peripheral and bone marrow stem cells was comparable. A myeloablative conditioning regimen was routinely used in patients with acute leukemia. This report provides an insight of HSCT trends in Pakistan which are different from those of Western centers contributing to transplant data from South Asia.

Objective: To determine the effect of high altitude on frequency and risk factors of venous thrombosis in individuals ascending to high altitude Study Design: Cross-sectional analytical study. Place and Duration of Study: Armed Forces Bone Marrow Transplant Centre, Combined Military Hospital Skardu, from Apr 2015 to Aug 2018. Methodology: High Altitude was taken as height equal to or more than 8000 feet. Polycythemia as hemoglobin >16.5 g/dl OR hematocrit >49%. Medical records of all patients evacuated from high altitude through Combined Military Hospital Skardu were analyzed retrospectively. A proforma was designed to include necessary variables. Results: We evaluated medical records of 539 individuals and found frequency of 86 (15.9%) for venous thromboembolism (VTE) at high altitude. Cerebral venous sinus thrombosis (CVST) was most common thrombotic complication seen in 39 patients (46%). Majority of thrombotic episodes occurred at >18000 feet (likelihood ratio (LR) 5.99, p-value 0.009). Majority of thrombotic episodes 34 (39%) occurred within first 45 days of ascent to high altitude. Thrombosis was linked to smoking 47 (55%) (likelihood ratio 21.3 and p-value

Objective: To determine the treatment outcome of Hematopoietic stem cell transplantation in Fanconi Anemia. Study Design: Case series. Place and Duration of Study: Armed Forces Bone Marrow Transplant Center, Rawalpindi, from Jan 2001 to Jun 2018. Methodology: Data of all Fanconi anemia patients who had fully HLA matched bone marrow transplant during this period was analysed for variables affecting the outcome in terms of overall survival. Those fanconi anemia patients who had myelodysplastic changes or acute myeloid leukemia were excluded. Results: Total 27 patients underwent fully HLA matched allogeneic bone marrow transplant for Fanconi Anemia. Mean age of patients at transplant was 12.12 ± 5.16 years. All patients at transplant were in aplastic phase. Conditioning was done with fludarabine 120mg/m2, ATG 20 mg/kg and Cyclophosphamide at a dose of 20-40 mg/kg. Mean time to neutrophil engraftment was 12.3 ± 2.92days and for platelets 20 ± 10.3 days. Major post-transplant complications were neutropenic fever in 26 (96%), hypertension in 18 (66.6%), mucositis in 12 (44.4%), azotaemia in 8 (29.6%), gut toxicity in 7 (25.9%) and haemorrhagic cystitis in 5 (18.5%) patients. Four patients (14.8%) had acute graft versus host disease while 7 (26%) patients had chronic GVHD. Overall survival at 6 months, 1, 5 and 8 years was 67%, 63%, 59% and 55% respectively. While overall survival in patients transplanted at younger age (11years) and was statistically significant (p-value = 0.03). Conclusion: Our study demonstrated survival difference in Fanconi anaemia patients when transplanted at younger age and conditioning with cyclophosphamide 30 mg/kg, fludarabine 120mg/m2 and thymoglobulin 10mg/kg as an acceptable conditioning protocol.

Vision loss is one of the main complications of eye disease, especially diabetic retinopathy (DR), because DR is a silent disease affecting the retina of the eye and resulting in loss of vision. Manual observation of eye disease takes time and delays effective treatment, so computerized methods are used to diagnose eye disease by extracting their features such as blood vessels, optic disc, and other abnormalities. Many computerized methods are proposed but it is still lacking to obtain small vessels. To overcome this problem, we have proposed methods based on image processing techniques for detection of retinal vessels. The proposed method is based on the elimination of uneven illumination using morphological tactics and principal component analysis. These initial steps are known as the preprocessing module, and our post-processing module contains the vessel coherence and the double threshold binarization method to obtain an image of the segmented vessels. Our proposed method obtained comparable results (average results (sensitivity: 0.78, specificity: 0.95 and precision: 0.951)) compared to the existing methods on the DRIVE and STARE databases.

Objective: Retrospective analysis to evaluate overall response and outcome of various therapeutic regimens given in patients with non acute promyelocytic acute myeloid leukaemia (non APL AML). Study Design: Retrospective study. Place and Duration of Study: Armed Forces Bone Marrow Transplant centre/ National Institute of Blood and Marrow Transplant (AFBMTC/NIBMT), Rawalpindi. Methodology: Patients of non APL AML managed at Armed Forces Bone Marrow Transplant Centre between Jul 2001 and Dec 2014 were evaluated. These patients included cases of denovo (n=103) and relapsed (n=18) AML cases. After baseline investigations bone marrow examination was carried out in all cases and cytogenetics and immunophenotyping in some cases. Informed written consent was taken before starting chemotherapy. The chemotherapy regimens used were D3A7, ADE, ICE, MAE, FLAG & FLAG-IDA and HiDAC. Majority of patients received induction with daunorubicin/cytarabine based chemotherapy. Post remission chemotherapy included either second course of D3A7/ADE combination or FLAG-Ida/ICE chemotherapy in relapsed AML followed by one to two courses of HiDAC (high dose cytarabine). Bone marrow examination was carried out after each course of chemotherapy to assess remission status. Results: Total 121 cases were evaluated. Median age of patients was 28 years with 68% males and 32% females. Sixty four (53%) patients were of AML-M2 subtype. All 121 cases received induction chemotherapy including 103 denovo and 18 relapsed patients. Anthracycline based chemotherapy was given to majority of denovo cases (68%) while most of the relapsed AML patients received FLAG-Ida regimen. Hematological complete remission (CR) was achieved in 37% of denovo and 58% of relapsed patients after first course. Twenty nine (24%) patients failed to respond 11% had partial remission while 19 (15%) died within four weeks post induction and 9% discontinued the treatment. Out of eighty patients who received second course of chemotherapy 60 (75%) achieved CR. Only 62 patients including 52 denovo and 10 relapsed cases completed four courses of chemotherapy and were followed for a period of one to five years after completion of treatment. Out of these 62 patients 31 (50%) achieved CR, six of these 31 subsequently relapsed and two are alive on palliation. Overall and disease free survival in patients who completed chemotherapy was 43% and 40% respectively. Conclusion: A significant number of patients with AML can be saved provided proper risk adapted chemotherapy is given. Standard induction with daunorubicin/cytarabine chemotherapy followed by two to three courses of high dose cytarabine is associated with overall and disease free survival in a significant proportion of cases.

Medical judgments are tough and challenging as the decisions are often based on deficient and ambiguous information. Moreover the result of decision process has direct effects on human lives. Act of human decision declines in emergency situations due to complication, time limit and high risks. Therefore, provision of medical diagnosis plays a dynamic role, specifically in preliminary stage when a physician has limited diagnosis experience and identifies the directions to be taken for the treatment process. Computerized Decision Support Systems have brought a revolution in the medical diagnosis. These automatic systems support the diagnosticians in the course of diagnosis. The major role of Decision Support Systems is to support the medical personnel in decision making procedures regarding disease diagnosis and treatment recommendation. The proposed system provides easy support in Hepatitis disease recognition. The system is developed using the Bayesian network model. The physician provides the input to the system in the form of symptoms stated by patient. These signs and symptoms match with the casual relationships present in the knowledge model. The Bayesian network infer conclusion from the knowledge model and calculate the probability of occurrence of Hepatitis B, C and D disorders.

PurposeCOVID-19 infection resulting from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began to spread across the globe in early 2020. Patients with hematologic malignancies are supposed to have an increased risk of mortality from coronavirus disease of 2019 (COVID-19) infection. From Pakistan, we report the analysis of the outcome and interaction between patient demographics and tumor subtype and COVID-19 infection and hematological malignancy.Patients and methodsThis multicenter, retrospective study included adult patients with a history of histologically proven hematological malignancies who were tested positive for COVID-19 via PCR presented at the oncology department of 5 tertiary care hospitals in Pakistan from February to August 2020. A patient with any known hematological malignancy who was positive for COVID-19 on RT-PCR, was included in the study. Chi-square test and Cox-regression hazard regression model was applied considering p ≤ 0.05 significant.ResultsA total of 107 patients with hematological malignancies were diagnosed with COVID-19, out of which 82 (76.64%) were alive, and 25 (23.36%) were dead. The significant hematological malignancy was B-cell Lymphoma in dead 4 (16.00%) and alive group 21 (25.61%), respectively. The majority of the patients in both the dead and alive group were on active treatment for hematological malignancy while they came positive for COVID-19 [21 (84.00%) & 48 (58.54%) p 0.020]. All patients in the dead group were admitted to the hospital 25 (100.00%), and among these, 14 (56.00%) were admitted in ICU with a median 11 (6-16.5) number of days. Among those who had contact exposure, the hazard of survival or death in patients with hematological malignancies and COVID-19 positive was 2.18 (CI: 1.90-4.44) times and 3.10 (CI: 2.73-4.60) times in patients with travel history compared to no exposure history (p 0.001).ConclusionTaken together, this data supports the emerging consensus that patients with hematologic malignancies experience significant morbidity and mortality resulting from COVID-19 infection.

In order to broaden the study of energetic cations, a cation 3,5-diamino-4H-pyrazol-4-one oxime (DAPO) with good thermal stability was proposed, and its three salts were synthesized by a simple and efficient method. The structures of the three salts were verified by infrared spectroscopy, mass spectrometry, elemental analysis, and single crystal X-ray diffraction. The thermal stabilities of the three salts were verified by differential scanning calorimetry and thermos-gravimetric analysis. DAPO-based energetic salts are analysed using a variety of theoretical techniques, such as 2D fingerprint, Hirshfeld surface, and non-covalent interaction. Among them, the energy properties of perchlorate (DAPOP) and picrate (DAPOT) were determined by EXPLO5 program combined with the measured density and enthalpy of formation. These compounds have high density, acceptable detonation performance, good thermal stability, and satisfactory sensitivity. The intermolecular interactions of the four compounds were studied by Hirshfeld surface and non-covalent interactions, indicating that hydrogen bonds and π–π stacking interactions are the reasons for the extracellular properties of perchlorate (DAPOP) and picrate (DAPOT), indicating that DAPO is an optional nitrogen-rich cation for the design and synthesis of novel energetic materials with excellent properties.

In the dairy sector, mastitis is one of the most important and costly diseases because, due to it, the world’s economy faces about 35 billion dollar loss each year. Bacterial pathogens that cause mastitis are called mastitogens. Among these bacterial species, Escherichia coli, Staphylococcus aureus, Streptococcus uberis, Streptococcus agalactia, and Streptococcus dysgalactia are the most important. Mastitis is treated with antibiotics; however, due to their improper, excessive, and irrational usage, these pathogens have become resistant to them. Drug residues in milk is also a factor resulting in multi-drug resistance (MDR) in mastitogens that cause treatment to become ineffective. In Pakistan, several ethnoveterinary plants, such as Allium sativum (garlic) and Chenopodium album (goosefoot), are used for the treatment of mastitis in cattle and buffalo. For this purpose, we prepared aqueous and methanol extracts of A. sativum and C. album. In the agar well diffusion method, the aqueous A. sativum showed strong activity against Staphylococcus aureus, i.e., 20 mm, whereas the methanolic extract of C. album gave an 11 mm zone of inhibition against Staphylococcus aureus. By combining the extracts of A. sativum and C. album, they give a synergistic effect, especially against E. coli. Results showed that the zone of inhibition against Staphylococcus aureus was 16 mm, against E. coli was 22 mm, and against Streptococcus uberis was 5 mm. Our study is in agreement with the use of A. sativum and C. album in cases of mastitis and recommends their combined use for better results.